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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710563
Report Date: 02/11/2025
Date Signed: 02/14/2025 01:48:16 PM

Document Has Been Signed on 02/14/2025 01:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DELOR MONTESSORI, INC.FACILITY NUMBER:
430710563
ADMINISTRATOR/
DIRECTOR:		MCGEOY, LORIFACILITY TYPE:
830
ADDRESS:1510 LEWISTON DRIVETELEPHONE:
(408) 773-0200
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 15TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
02/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Yessica RosalesTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA)Mandeep Kaur met with Head Teacher, Yessica Rosales for an unannounced Annual/Random Inspection. The purpose of today's inspection was explained with Head Teacher. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 07:30 AM to 5:30 PM. The infant program is licensed to serve children from 0 to 24 months in an Infant Room.

LPA toured the indoor and outdoor areas. LPA observed that the teacher-child ratio was in compliance. Fire
drill was conducted on January 30, 2025. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. Head Teacher stated that the center has a third party cleaning service that comes and clean the facility after daycare hours.

The center provides morning snacks and afternoon snacks to the children. There is a kitchen at the
facility for food preparation. The kitchen is equipped with a refrigerator, microwave, dishwasher, storage space for food, and a sink with hot and cold running water. Drinking water is available for the children
indoor via filtered water connected to a tap. LPA observed trash cans with tight fitting covers for the
disposable of solid waste. The facility has fire extinguishers and working smoke and carbon monoxide
detectors.

Continuation on next pages:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DELOR MONTESSORI, INC.
FACILITY NUMBER: 430710563
VISIT DATE: 02/11/2025
NARRATIVE
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The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided. Drinking water is readily available for the children outdoor via sippy cups and filtered water attached to a tap. LPA observed play structure with resilient material under and around the structure. There were no bodies of water observed. Head Teacher stated that there are no weapons or firearms on the premises.

LPA reviewed 4 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Immunizations, Parent Right's Receipt, Personal Rights, and Health History.

LPA reviewed 3 staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles,
Pertussis, and Influenza) and required training. Based on records review, Staff(S3) is missing measels. LPA reminded Head Teacher that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Head Teacher was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continuation on next page:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DELOR MONTESSORI, INC.
FACILITY NUMBER: 430710563
VISIT DATE: 02/11/2025
NARRATIVE
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LPA discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed Site Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs)
constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead
contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA referred Head Teacher to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Head Teacher was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address
provided. Please complete the survey and share your inspection experience. If you have any questions
regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional
information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, three Type B deficiencies were cited on the following pages. Appeal rights provided.

Exit interview conducted and report was reviewed with Head Teacher, Yessica Rosales.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/14/2025 01:48 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 02/11/2025 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI, INC.
FACILITY NUMBER: 430710563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before
January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than
January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2025
Plan of Correction
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By date 02/25/2025, the facility will submit the proof of the work order. By plan of correction due date , 03/13/2025, the center will submit lead test results.
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants: (a) In addition to Section 101229, the following shall apply:(2) Sleeping infant(s) shall be directly observed by sight and sound at all times. (B)Staff shall physically check on sleeping infant(s) every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews, records review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/25/2025
Plan of Correction
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By Plan of correction Due date, 02/25/2025, Licensee will submit the proof of infant safe sleep log for every 15 minutes for each infant up till the age of 24 months.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Belinda Devall
LICENSING EVALUATOR NAME:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


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Document Has Been Signed on 02/14/2025 01:48 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 02/11/2025 at 03:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI, INC.
FACILITY NUMBER: 430710563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 of the staff (S3) which poses a potential health, safety or personal rights risk to persons in care. Staff #3 is missing Measles.
POC Due Date: 03/13/2025
Plan of Correction
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By Plan of correction due date 03/13/2025, the center will submit the proof of the Immunization records: Staff # 3 missing Measles.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Belinda Devall
LICENSING EVALUATOR NAME:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


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